Provider Demographics
NPI:1689481400
Name:CALLAHAN, JOSEPH (LPN (MILITARY MEDIC))
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:LPN (MILITARY MEDIC)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16642 MAUDE DR
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-4321
Mailing Address - Country:US
Mailing Address - Phone:813-293-8963
Mailing Address - Fax:
Practice Address - Street 1:16642 MAUDE DR
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-4321
Practice Address - Country:US
Practice Address - Phone:813-293-8963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Multi-Specialty